Burn | |
---|---|
Second-degree burn of the hand | |
Specialty | Dermatology, critical care medicine, plastic surgery[1] |
Symptoms | First degree: Red without blisters[2] Second degree: Blisters and pain[2] Third degree: Area stiff and not painful[2] Fourth degree: Bone and tendon loss[3] |
Complications | Infection[4]
Metabolic: protein and lean muscle loss Scarring: keloid/hypertrophic Cardiovascular complications Neuropathy Heterotrophic ossification |
Duration | Days to weeks[2] |
Types | First degree, second degree, third degree,[2] fourth degree[3] |
Causes | Heat, cold, electricity, chemicals, friction, radiation[5] |
Risk factors | Open cooking fires, unsafe cooking stoves, smoking, alcoholism, dangerous work environment[6] |
Treatment | Depends on the severity[2]
Antiseptics Analgesics Dressings Wound management Respiratory management Skin grafts: cloned skin, autografts and adjacent tissue grafts
Positioning and splinting Active and passive exercise Resistive and conditioning exercise Aerobic exercise Respiratory management Ambulation Scar management: pressure garment, dressing, silicone gel |
Medication | Pain medication, intravenous fluids, tetanus toxoid[2] |
Frequency | 67 million (2015)[7] |
Deaths | 176,000 (2015)[8] |
A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ionizing radiation (such as sunburn, caused by ultraviolet radiation).[5][9] Most burns are due to heat from hot liquids (called scalding), solids, or fire.[10] Burns occur mainly in the home or the workplace. In the home, risks are associated with domestic kitchens, including stoves, flames, and hot liquids.[6] In the workplace, risks are associated with fire and chemical and electric burns.[6] Alcoholism and smoking are other risk factors.[6] Burns can also occur as a result of self-harm or violence between people (assault).[6]
Burns that affect only the superficial skin layers are known as superficial or first-degree burns.[2][11] They appear red without blisters, and pain typically lasts around three days.[2][11] When the injury extends into some of the underlying skin layer, it is a partial-thickness or second-degree burn.[2] Blisters are frequently present and they are often very painful.[2] Healing can require up to eight weeks and scarring may occur.[2] In a full-thickness or third-degree burn, the injury extends to all layers of the skin.[2] Often there is no pain and the burnt area is stiff.[2] Healing typically does not occur on its own.[2] A fourth-degree burn additionally involves injury to deeper tissues, such as muscle, tendons, or bone.[2] The burn is often black and frequently leads to loss of the burned part.[2][12]
Burns are generally preventable.[6] Treatment depends on the severity of the burn.[2] Superficial burns may be managed with little more than simple pain medication, while major burns may require prolonged treatment in specialized burn centers.[2] Cooling with tap water may help pain and decrease damage; however, prolonged cooling may result in low body temperature.[2][11] Partial-thickness burns may require cleaning with soap and water, followed by dressings.[2] It is not clear how to manage blisters, but it is probably reasonable to leave them intact if small and drain them if large.[2] Full-thickness burns usually require surgical treatments, such as skin grafting.[2] Extensive burns often require large amounts of intravenous fluid, due to capillary fluid leakage and tissue swelling.[11] The most common complications of burns involve infection.[4] Tetanus toxoid should be given if not up to date.[2]
In 2015, fire and heat resulted in 67 million injuries.[7] This resulted in about 2.9 million hospitalizations and 176,000 deaths.[8][13] Among women in much of the world, burns are most commonly related to the use of open cooking fires or unsafe cook stoves.[6] Among men, they are more likely a result of unsafe workplace conditions.[6] Most deaths due to burns occur in the developing world, particularly in Southeast Asia.[6] While large burns can be fatal, treatments developed since 1960 have improved outcomes, especially in children and young adults.[14] In the United States, approximately 96% of those admitted to a burn center survive their injuries.[15] The long-term outcome is related to the size of burn and the age of the person affected.[2]